cardiac practice quiz
After teaching a patient with chronic stable angina about nitroglycerin, the nurse recognizes the need for further teaching when the patient makes which statement? "I will take the nitroglycerin 10 minutes before planned activity that usually causes chest pain." "I will take acetaminophen (Tylenol) to treat the headache caused by nitroglycerin." "I will replace my nitroglycerin supply every 6 months." "I can take up to five tablets every 3 minutes for relief of my chest pain."
"I can take up to five tablets every 3 minutes for relief of my chest pain."
The nurse instructs a 68-year-old woman with hypercholesterolemia about natural lipid-lowering therapies. The nurse determines further teaching is necessary if the patient makes which statement? "I will take garlic instead of my prescription medication to reduce my cholesterol." "I should check with my physician before I start taking any herbal products." "Herbal products do not go through as extensive testing as prescription drugs do." "Omega-3 fatty acids are helpful in reducing triglyceride levels."
"I will take garlic instead of my prescription medication to reduce my cholesterol."
After teaching about ways to decrease risk factors for CAD, the nurse recognizes that additional instruction is needed when the patient says "I will change my lifestyle to reduce activities that increase my stress." "I can only keep my blood pressure normal with medication." "I can change my diet to decrease my intake of saturated fats." "I would like to add weight lifting to my exercise program."
"I would like to add weight lifting to my exercise program." Risk factors for coronary artery disease include elevated serum levels of lipids, elevated blood pressure, tobacco use, physical inactivity, obesity, diabetes, metabolic syndrome, certain psychologic states, and elevated homocysteine levels. Weight lifting is not a cardioprotective exercise. An example of health-promoting regular physical activity is brisk walking (3 to 4 miles/hr) for at least 30 minutes five or more times each week.
In caring for the patient with angina, the patient said, "I walked to the bathroom. While I was having a bowel movement, I started having the worst chest pain ever, like before I was admitted. I called for a nurse, but the pain is gone now." What further assessment data should the nurse obtain from the patient? "What precipitated the pain?" "In what areas did you feel this pain?" "Has the pain changed this time?" "Rate the pain on a scale from 0 to 10, with
"In what areas did you feel this pain?"
A 70-year-old woman with chronic heart failure and atrial fibrillation asks the nurse why warfarin has been prescribed for her to continue at home. Which response by the nurse is accurate? "The medication reduces clotting by decreasing serum potassium levels." "The medication dissolves clots that develop in your coronary arteries." "The medication increases your heart rate so that clots do not form in your heart." "The medication prevents blood clots from forming in your heart." .
"The medication prevents blood clots from forming in your heart." .
The nurse is caring for a patient newly diagnosed with heart failure. The patient is to receive a first dose of digoxin 0.125 mg IV push. An ampule containing 0.25 mg/mL is available. Calculate the number of milliliters the nurse should draw up to administer this dose. ______ Record answer to the nearest tenth
0.5
Which patient is at greatest risk for sudden cardiac death? A 52-year-old African American man with left ventricular failure A 42-year-old white woman with hypertension and dyslipidemia A 62-year-old obese man with diabetes mellitus and high cholesterol A 72-year-old Native American woman with a family history of heart disease
A 52-year-old African American man with left ventricular failure
The nurse is administering a dose of digoxin to a patient with heart failure (HF). The nurse would become concerned with the possibility of digitalis toxicity if the patient reported which symptom(s)? Muscle aches Pounding headache Constipation Anorexia and nausea .
Anorexia and nausea .
A patient is admitted to the ICU with a diagnosis of unstable angina. Which medication(s) would the nurse expect the patient to receive (select all that apply)? ACE inhibitor Antiplatelet therapy Prophylactic antibiotics Intravenous nitroglycerin Thrombolytic therapy
ACE inhibitor Antiplatelet therapy Intravenous nitroglycerin In addition to oxygen, several medications may be used to treat unstable angina (UA): nitroglycerin, aspirin (chewable), and morphine. For patients with UA with negative cardiac markers and ongoing angina, a combination of aspirin, heparin, and a glycoprotein IIb/IIIa inhibitor (e.g., eptifibatide [Integrilin]) is recommended. Angiotensin-converting enzyme (ACE) inhibitors decrease myocardial oxygen demand by producing vasodilation, reducing blood volume, and slowing or reversing cardiac remodeling.
The patient is being dismissed from the hospital after ACS and will be attending rehabilitation. What information does the patient need to be taught about the early recovery phase of rehabilitation? Activity level is gradually increased under cardiac rehabilitation team supervision and with ECG monitoring. Therapeutic lifestyle changes should become lifelong habits. Attention will focus on management of chest pain, anxiety, dysrhythmias, and other complications. Physical activity is always started in the hospital and continued at home.
Activity level is gradually increased under cardiac rehabilitation team supervision and with ECG monitoring.
The patient comes to the ED with severe, prolonged angina that is not immediately reversible. The nurse knows that if the patient once had angina related to a stable atherosclerotic plaque and the plaque ruptures, there may be occlusion of a coronary vessel and this type of pain. How will the nurse document this situation related to pathophysiology, presentation, diagnosis, prognosis, and interventions for this disorder? ST-segment-elevation myocardial infarction (STEMI) Acute coronary syndrome (ACS) Unstable angina Non-ST-segment-elevation myocardial infarction (NSTEMI)
Acute coronary syndrome (ACS)
For which problem is percutaneous coronary intervention (PCI) most clearly indicated? Chronic stable angina Acute myocardial infarction Coronary artery disease Left-sided heart failure
Acute myocardial infarction
A 54-year-old male patient who had bladder surgery 2 days ago develops acute decompensated heart failure (ADHF) with severe dyspnea. Which action by the nurse would be indicated first? Restrict the patient's oral fluid intake to 500 mL per day. Assist the patient to a sitting position with arms on the overbed table. Perform a bladder scan to assess for urinary retention. Instruct the patient to use pursed-lip breathing until the dyspnea subsides.
Assist the patient to a sitting position with arms on the overbed table. .
Postoperative care of a patient undergoing coronary artery bypass graft (CABG) surgery includes monitoring for what common complication? Acute respiratory distress syndrome Atrial dysrhythmias Paralytic ileus Dehydration
Atrial dysrhythmias
A patient is recovering from an uncomplicated MI. Which rehabilitation guideline is a priority to include in the teaching plan? Plan a diet program that aims for a 1- to 2-pound weight loss per week. Consider the use of erectile agents and prophylactic NTG before engaging in sexual activity. Begin an exercise program that aims for at least five 30-minute sessions per week. Refrain from sexual activity for a minimum of 3 weeks.
Begin an exercise program that aims for at least five 30-minute sessions per week.
What is the priority assessment by the nurse caring for a patient receiving IV nesiritide to treat heart failure? Blood pressure Respiratory rate Lung sounds Urine output
Blood pressure .
A patient was admitted to the emergency department (ED) 24 hours earlier with complaints of chest pain that were subsequently attributed to ST-segment-elevation myocardial infarction (STEMI). What complication of MI should the nurse anticipate? Unstable angina Sudden cardiac death Cardiac dysrhythmias Cardiac tamponade
Cardiac dysrhythmias
Beyond the first year after a heart transplant, the nurse knows that what is a major cause of death? Acute rejection Cardiac vasculopathy Immunosuppression Infection
Cardiac vasculopathy
A male patient with a long-standing history of heart failure has recently qualified for hospice care. What measure should the nurse now prioritize when providing care for this patient? Choose interventions to promote comfort and prevent suffering. Taper the patient off his current medications. Continue education for the patient and his family. Pursue experimental therapies or surgical options.
Choose interventions to promote comfort and prevent suffering. .
The patient has heart failure (HF) with an ejection fraction of less than 40%. What core measures should the nurse expect to include in the plan of care for this patient (select all that apply)? Left ventricular function is documented. . Prescription for angiotensin-converting enzyme (ACE) inhibitor at discharge . Prescription for digoxin at discharge Education materials about activity, medications, weight monitoring, and what to do if symptoms worsen . Controlling dysrhythmias will eliminate HF.
Correct Answer Left ventricular function is documented. . Correct! Prescription for angiotensin-converting enzyme
In teaching a patient about coronary artery disease, the nurse explains that the changes that occur in this disorder include (select all that apply) accumulation of lipid and fibrous tissue within the coronary arteries. development of angina due to a decreased blood supply to the heart muscle. abnormal levels of cholesterol, especially low-density lipoproteins. diffuse involvement of plaque formation in coronary veins. chronic vasoconstriction of coronary arteries leading to permanent vasospasm.
Correct! accumulation of lipid and fibrous tissue within the coronary arteries. Correct! development of angina due to a decreased blood supply to the heart muscle. Correct! abnormal levels of cholesterol, especially low-density lipoproteins.
The nurse is providing teaching to a patient recovering from an MI. How should resumption of sexual activity be discussed? Accomplished by providing the patient with written material Discussed along with other physical activities Delegated to the primary care provider Avoided because it is embarrassing to the patient
Discussed along with other physical activities
A patient with a diagnosis of heart failure has been started on a nitroglycerin patch by his primary care provider. What should this patient be taught to avoid? High-potassium foods Nonsteroidal antiinflammatory drugs Over-the-counter H2-receptor blockers Drugs to treat erectile dysfunction .
Drugs to treat erectile dysfunction .
The nurse prepares a discharge teaching plan for a 44-year-old male patient who has recently been diagnosed with coronary artery disease. Which risk factor should the nurse plan to focus on during the teaching session? Elevated serum lipids Type A personality Hyperhomocysteinemia Family cardiac history
Elevated serum lipids
Which antilipemic medications should the nurse question for a patient with cirrhosis of the liver (select all that apply)? Ezetimibe Niacin Gemfibrozil Atorvastatin Cholestyramin
Ezetimibe Gemfibrozil Atorvastatin
What should the nurse recognize as an indication for the use of dopamine in the care of a patient with heart failure? Peripheral edema and weight gain Hypotension and tachycardia Acute anxiety Paroxysmal nocturnal dyspnea (PND)
Hypotension and tachycardia .
A patient experienced sudden cardiac death (SCD) and survived. What should the nurse expect to be used as preventive treatment for the patient? Implantable cardioverter-defibrillator (ICD) External pacemaker Medications to prevent dysrhythmias An electrophysiologic study (EPS)
Implantable cardioverter-defibrillator (ICD)
A patient admitted with heart failure appears very anxious and complains of shortness of breath. Which nursing actions would be appropriate to alleviate this patient's anxiety (select all that apply)? Instruct patient on the use of relaxation techniques. . Use a calm, reassuring approach while talking to patient. Position patient in a semi-Fowler's position. Position patient on left side with head of bed flat. Administer ordered morphine sulfate. .
Instruct patient on the use of relaxation techniques Use a calm, reassuring approach while talking to patient. Position patient in a semi-Fowler's position. Administer ordered morphine sulfate. .
A female patient who has type 1 diabetes mellitus has chronic stable angina that is controlled with rest. She states that over the past few months she has required increasing amounts of insulin. What goal should the nurse use to plan care that should help prevent cardiovascular disease progression? Limit calories to daily limit. Avoid saturated fat intake. Exercise almost every day. Keep Hgb A1C less than 7%.
Keep Hgb A1C less than 7%.
The nurse would assess a patient with complaints of chest pain for which clinical manifestations associated with a myocardial infarction (MI) (select all that apply)? Flushing Nausea and vomiting Diaphoresis S3 or S4 heart sounds Ashen skin
Nausea and vomiting Diaphoresis S3 or S4 heart sounds Ashen skin
A 74-year-old man with a history of prostate cancer and hypertension is admitted to the emergency department with substernal chest pain. Which action will the nurse complete before administering sublingual nitroglycerin? Obtain a 12-lead electrocardiogram (ECG). Auscultate heart and lung sounds. Administer morphine sulfate IV. Assess for coronary artery disease risk factors.
Obtain a 12-lead electrocardiogram (ECG)
The nurse is caring for a patient who is 2 days post-MI. The patient reports that she is experiencing chest pain. She states, "It hurts when I take a deep breath." Which action would be a priority? Apply high-flow oxygen by face mask and auscultate breath sounds. Medicate the patient with PRN analgesic and reevaluate in 30 minutes. Notify the physician STAT and obtain a 12-lead ECG. Obtain vital signs and auscultate for a pericardial friction rub.
Obtain vital signs and auscultate for a pericardial friction rub.
When planning emergent care for a patient with a suspected MI, what should the nurse anticipate administrating? Oxygen, nitroglycerin, aspirin, and morphine Aspirin, nitroprusside (Nipride), dopamine (Intropin), and oxygen Nitroglycerin, lorazepam (Ativan), oxygen, and warfarin (Coumadin) Oxygen, furosemide (Lasix), nitroglycerin, and meperidine
Oxygen, nitroglycerin, aspirin, and morphine
The nurse is examining the ECG of a patient who has just been admitted with a suspected MI. Which ECG change is most indicative of prolonged or complete coronary occlusion? Sinus tachycardia Fibrillatory P waves Pathologic Q wave Prolonged PR interval
Pathologic Q wave
A patient with a recent diagnosis of heart failure has been prescribed furosemide in an effort to physiologically do what for the patient? Promote vasodilation. Decrease afterload. Reduce preload Increase contractility.
Reduce preload. .
After having an MI, the nurse notes the patient has jugular venous distention, gained weight, developed peripheral edema, and has a heart rate of 108/minute. What should the nurse suspect is happening? ADHF Chronic HF Left-sided HF Right-sided HF .
Right-sided HF
The nurse prepares to administer digoxin 0.125 mg to an 82-year-old man admitted with influenza and a history of chronic heart failure. What should the nurse assess before giving the medication? Urine specific gravity Serum potassium level . Prothrombin time Hemoglobin and hematocrit
Serum potassium level .
The home care nurse visits a 73-year-old Hispanic woman with chronic heart failure. Which clinical manifestations, if assessed by the nurse, would indicate acute decompensated heart failure (pulmonary edema)? Severe dyspnea and blood-streaked, frothy sputum . Respirations 26 breaths/minute despite oxygen by nasal cannula Fatigue, orthopnea, and dependent edema Temperature is 100.4o F and pulse is 102 beats/minute
Severe dyspnea and blood-streaked, frothy sputum
The patient with chronic heart failure is being discharged from the hospital. What information should the nurse emphasize in the patient's discharge teaching to prevent progression of the disease to ADHF? Take medications as prescribed. Encourage most activity in the morning when rested. Only ask the physician's office questions. Use oxygen when feeling short of breath.
Take medications as prescribed. .
A male patient who has coronary artery disease (CAD) has serum lipid values of LDL cholesterol 98 mg/dL and HDL cholesterol 47 mg/dL. What should the nurse include in the patient teaching? Reduce total caloric intake. The lipid levels are normal. Increase intake of olive oil. Consume a diet low in fats.
The lipid levels are normal.
The nurse is preparing to administer digoxin to a patient with heart failure. In preparation, laboratory results are reviewed with the following findings: sodium 139 mEq/L, potassium 5.6 mEq/L, chloride 103 mEq/L, and glucose 106 mg/dL. What should the nurse do next? Give the digoxin with a salty snack, such as crackers. Withhold the daily dose until the following day. Withhold the dose and report the potassium level. Give the digoxin with extra fluids to dilute the sodium level.
Withhold the dose and report the potassium level. .
The nurse recognizes that primary manifestations of systolic failure include decreased pulmonary hypertension associated with normal EF. decreased PAWP and increased EF. decreased afterload and decreased left ventricular end-diastolic pressure. decreased EF and increased PAWP.
decreased EF and increased PAWP. Systolic heart failure results in systolic failure in the left ventricle (LV). The LV loses its ability to generate enough pressure to eject blood forward through the aorta. This results in increased pulmonary artery wedge pressure (PAWP). The hallmark of systolic failure is a decrease in the left ventricular ejection fraction (EF).
The most common finding in individuals at risk for sudden cardiac death is atherosclerotic heart disease. mitral valve disease. aortic valve disease. left ventricular dysfunction.
left ventricular dysfunction.
A 52-year-old male patient has received a bolus dose and an infusion of alteplase for an ST-segment elevation myocardial infarction (STEMI). To determine the effectiveness of this medication, the nurse should assess the patient for the presence of chest pain. blood in the urine or stool. decreased level of consciousness. tachycardia with hypotension.
presence of chest pain.
A hospitalized patient with a history of chronic stable angina tells the nurse that she is having chest pain. The nurse bases his actions on the knowledge that ischemia is frequently associated with vomiting and extreme fatigue. indicates that irreversible myocardial damage is occurring. will always progress to myocardial infarction. will be relieved by rest, nitroglycerin, or both.
will be relieved by rest, nitroglycerin, or both.
